Using combined data from the 2020–2024 California Health Interview Survey (CHIS), authors of this fact sheet examined the prevalence of suicidal thoughts and attempts among American Indian and Alaska Native (AIAN) adults in California and found that those rates were higher when compared with all California adults.

This study helps fill a crucial gap in representative data on suicidal thoughts and behaviors among AIAN adults in California.

Findings:

• About 1 in 11 AIAN adults (9%) in California had attempted suicide in their lifetime, nearly double the percentage for all adults (5%).
• About 1 in 4 AIAN adults (24%) in California had ever seriously thought about suicide, significantly higher than California adults overall (18%).
• Among AIAN adults in California who reported having had suicidal thoughts, more than 1 in 3 had ever attempted suicide (37%), a rate significantly higher than that for all adults in the state who reported ever having had suicidal thoughts (30%).
   

American Indian and Alaska Native (AIAN) populations face longstanding barriers to healthcare. 

Using data from the 2020–2024 California Health Interview Survey (CHIS), this fact sheet examines healthcare access among AIAN adults in California across six indicators: health insurance coverage, usual source of care, preventive care visits, emergency department visits, delays in accessing needed medical care, and delays in filling prescribed medication. American Indian and Alaska Native adults in California fared worse on all of them compared with all adults in the state.

Access to timely and appropriate healthcare is a fundamental determinant of health and a crucial component of preventing and managing disease. These results suggest a need to make culturally responsive and geographically accessible primary care more available, especially for rural communities.

Findings:

• Nearly 1 in 7 AIAN adults (14%) did not have health insurance for all or part of the past year compared with 10% of all California adults. 
• About 1 in 5 AIAN adults (21%) delayed needed medical care in the past year compared with 18% of all California adults. 
• More than 1 in 3 AIAN adults (35%) had no preventive care visits in the past year, which was higher than the state average.
• Nearly 1 in 4 AIAN adults (22%) had no place they usually go for medical care, compared to fewer than 1 in 5 of all adults (19%).
   

American Indian and Alaska Native (AIAN) adults in California reported significantly more adverse childhood experiences (ACEs) than adults overall in the state, based on combined data from the 2021–2024 California Health Interview Survey (CHIS).

Experiencing a higher number of ACEs is associated with progressively worse outcomes, with the highest risk found among individuals exposed to four or more ACEs.

Findings:

• 4 in 5 AIAN adults (80%) in the state reported experiencing at least one adverse childhood experience, significantly more than the 67% of all California adults who reported the same. 
• More than 1 in 3 AIAN adults (36%) experienced at least four ACEs, and more than 1 in 5 experienced at least five ACEs (22%), roughly double the rates seen for all adults in California (20% and 11%, respectively).
• More than half of AIAN adults in California (53%) reported experiencing emotional abuse, significantly more than all California adults (39%).
• All types of ACEs were relatively common: substance use in the household (43%), physical abuse (35%), parental divorce or separation (34%), witnessing intimate partner violence (33%), mental illness in the household (31%), sexual abuse (26%), and incarceration of someone in the household (18%).

American Indian and Alaska Native (AIAN) populations face significant chronic disease and substance use burdens compared to other populations. However, the differences that exist within this broader population remain understudied in California. Using combined 2020–2024 California Health Interview Survey (CHIS) data for AIAN adults, this policy brief highlights variations in chronic conditions and substance use across AIAN subpopulation groups.

Selected Findings

• American Indian and Alaska Native (AIAN) adults in California experience substantial burdens of chronic conditions, including diabetes, heart disease, hypertension, and uncontrolled blood pressure, and of substance use including smoking, marijuana use, and binge drinking.
• These burdens are not shared equally across AIAN subpopulations, those with lower incomes or lower educational attainment reported higher rates of living with diabetes and uncontrolled blood pressure. 
• Among AIAN adults living with hypertension, those identifying as lesbian, gay, bisexual, pansexual, or another nonheterosexual identity (LGBP+) were more than twice as likely as heterosexual adults to have uncontrolled blood pressure. 
• Substance use also differed by income, with smoking more common among lower-incomes AIAN adults and binge drinking more common among higher-income adults.
•  Marijuana use was markedly higher among LGBP+ and transgender and gender-expansive AIAN adults than their heterosexual and cisgender peers.